Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 036100522 | IL |
NPI | 1033222625 |
---|---|
Provider Name | Dr. David R Knox |
First Address | Urbana, IL 61801-2500 |
Second Address | Mattoon, IL 61938-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 20/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036100522 | (05) | IL |
H19816 | (02) | |
H19816 | (02) | IL |